Radiology at GUMC and the Southeast Alaska. Regional Health Corporation (SEARHC) in Sitka. Regional ... on a consortium including GUMC, Mt. Edgecumbe.
Project RavenCare in Alaska: Initial Implementation Walid G. Tohme, Jeff Collmann, Seong K. Mun, David J. Vastola" Department of Radiology, Georgetown University Hospital, Washington, DC 20007 * Mt. Edgecumbe Hospital /SEARHC, Sitka, AK 99835 Abstract As previously reported [4], Project Ravencare is based on a consortium including GUMC, Mt. Edgecumbe Hospital, a SEARHC regional hospital in Sitka, and a SEARHC village clinic at Hoonah. Communication links for the three sites will be provided by NASA's ACTS through T-1 VSAT connection.
Project RavenCare is an initiative designed to provide sustained routine clinical telemedicine/telerudiology support for a village clinic in Hoonah, Alaska and Mt. Edgecumbe Hospital in Sitka. The village clinic is linked to the regional hospital and this hospital is in turn linked to Georgetown University Medical Center ( G U M C ) through the NASA-ACTS (Advanced Communication Technology Satellite). Project Ravencare is a joint project between the department of Radiology at GUMC and the Southeast Alaska Regional Health Corporation (SEARHC) in Sitka. Regional physicians in Hoonah luck support in providing relatively routine care in areas such as radiology and pathology. This project will address the existing communication problem between the village health clinics and the hospital as well as the lack of subspecialty support for hospital-based physicians in Sitka.
2: Clinical Needs Assessment Native Alaskans suffer from the same chronic illnesses found in the general population including cardiovascular disease and cancer. There are more special concerns such as trauma related to alcohol abuse, dog bites and high risk pregnancies. CHAs constitute the backbone of the Native Alaskan health care system providing most primary health care to native villages throughout Alaska. The CHA program has brought tremendous improvements to the healthcare situation in Native Alaskan villages [6], this communication process has several problems in the following areas: * The speed of the communication process: Each communication takes about ten to twenty minutes per patient and one to two hours per village depending on the patient volume and case complexity.
1: Introduction Several barriers to providing adequate health care exist in many rural and isolated areas in the United States. Health care delivery for Native Americans in Alaska is a perfect example of this. It is not only difficult but also very expensive because the relatively few beneficiaries are scattered throughout a vast region with no reliable transportation or communication systems. Native Alaskan Community Health Aides (CHAs) provide most primary care at village clinics under the supervision of doctors located at regional hospitals. Patients requiring secondary and tertiary levels of care are transported to the appropriate facilities. This exposes the patients to a great amount of risk as well as being representing a great financial burden. A better alternative to this is to treat patients in their own villages but the limited telecommunications infrastructure severely hampers that possibility. Previous experiments were reported in Alaska in the 70s [ 1,2,3] but today's technologies allow much greater possibilities.
0-8186-5860-6/96 $5.00 0 1996 IEEE Proceedings of National Forum '95
* The possibility of errors: Since the data is manually recorded several times, the probability of errors increases.
* The comprehensiveness of the communication: The communication between the CHA and the physician is difficult and depends on the level of experience of the CHA and how well the CHA and the physician know each other. * Thefrequency of sharing patient data and information: Patient data and records are infrequently shared between the village health clinic and the regional hospitals. CHAs express a genuine sense of being medically alone and in constant demand. Physicians report that even experienced community health aides are sometimes unwilling to answer general questions related to whether the patient looks critically ill or not. This is a difficult
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assessment to many CHAs but not for the experienced clinician. These difficulties require physicians to transport some patients from the village to the regional hospital merely because they cannot obtain comprehensive diagnostic information.
telemedicine consultation and will constitute a vital link between the clinic in Hoonah and the larger regional hospital in Sitka. The interactive nature of the project will allow patients and physicians in Hoonah or Sitka to communicate directly with each other as well as with specialists at Georgetown.
3: Project Description The advantages of this project Native Alaskan patients are: -removing time and distance barriers for diagnostic medicine for rural areas, -dramatically improving the level of care to the Sitka regional hospital and remote village clinics, -cost savings from decreased patient transfer costs and travel expenses which constitute the single most taxing expense on the Native Alaskan health care system. -the beginning of a new integrated health care support network for the Native Alaskan population.
Project Ravencare will provide a telemedicine/teleradiology link between Mt. Edgecumbe Hospital in Sitka, Alaska and GUMC. The services provided here include transmission of bone and chest images from Sitka to Georgetown. There is no subspecialty radiology services available at Sitka and only one radiologist is on staff at Mt. Edgecumbe. This service will be augmented by a multimedia ability between GUMC and Sitka. We refer to this combined service as multimedia teleradiology. The second type of service that will be provided later is the implementation of a two-way teleconferencing link between Hoonah and Sitka. This will enable the two sites to perform live
Project RavenCare Initiative ACTS Satellite
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ICINE
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Hoonah Village
Georgetown University Medical Center
Hospital
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Electronic Patient Encounter Form With Each Health Aid Figure 1
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SEARHC Community Health Program
Ground Connectivities A
BeamAntenna Steerable Antenna
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NASA ACTS Satellite
Georgetown University Medical Center Washington, DC
